Welcome to Parkland Community Health Plan

Texas STAR Medicaid members

Texas CHIP & CHIP Perinate members

Providers

At Parkland Community Health Plan, we believe in improving every life we touch as good stewards to those we serve.

For Members: Welcome to Parkland Community Health Plan! If you are eligible for Medicaid, we can help. We offer these program services:- The Medicaid Program (STAR) - The Children’s Health Insurance Program (CHIP/CHIP Perinate)

Parkland Community Health Plan has proudly served the people of Texas since 1999. You’ll feel comfortable knowing that thousands of Texans get health care benefits through our plan services.

When you join Parkland Community Health Plan, you can:- Choose your own doctor, close to home- Call to speak to a nurse anytime, 24/7- Get extra benefits – special programs to meet your health care goals

We have special services for people who have trouble reading, hearing, seeing, or speak a language other than English or Spanish. We provide free aids and services to people with disabilities to communicate effectively with us, such as:

Qualified sign language interpreters

Written information in other formats (large print, audio, accessible electronic formats, other formats)

We also provide free language services to people whose primary language is not English, such as:

If you need a qualified interpreter, written information in other formats, translation or other services, just call or write Parkland HEALTHfirst Member Services at 1-888-672-2277, KIDSfirst Member Services at 1-888-814-2351, TTY 1-800-735-2989 or mail to:Parkland Community Health PlanAttention: Member Services5200 Harry Hines BlvdDallas, TX 75235

24-Hour Nurse Line

As a member of Parkland Community Health Plan, you can talk to a nurse when you have health questions. You can call the nurse line 24 hours a day, 7 days a week. English/Spanish/interpreter services are available 24 hours/day, 7 days/week. Even better, this service is provided at no cost to you. The nurse can answer your questions and help you make health decisions. You can call the nurse line at:

Parkland HEALTHfirst Medicaid STAR 1-888-667-7890 or 214-266-8773Parkland KIDSfirst CHIP/CHIP Perinate 1-800-357-3162 or 214-266-8766For members who are deaf or hard of hearing, you can call us toll-free at 1-800-735-2989.

If you have an emergency, please call 911.

In an emergency

An emergency is when you have a very serious injury or illness. You may be hurt badly, or bleeding heavily. You might be feeling very bad pain or feeling very, very sick. If you don’t get help, you may have permanent damage to a body part or you could even die.

Go to the nearest hospital or call 911 right away when:

You are afraid you may be dying

You are badly hurt

You have very bad chest pains

You may be poisoned

You may have taken an overdose of medicine

You are choking or having problems breathing

You may have a broken bone

You have diarrhea or vomiting that won’t stop

You are bleeding heavily

You are badly burned

You fainted

You suddenly can’t move (paralysis)

You are a victim of a violent attack (rape, mugging, stab or gunshot wound)

You have thoughts of causing harm to yourself or others

You are about to deliver a baby

For many illnesses, you don’t need to go to the emergency room. If you have a cold, a cough or a rash, you can call your doctor. It’s the same if you have small cuts or bruises. You don’t need to go to the hospital. If you’re unsure, you can call our nurse line. The nurse can help you decide if you need to go to the emergency room.

Nurse line - you can talk to a nurse when you have health questions. You can call the nurse line 24 hours a day, 7 days a week.

If you feel that you can wait to seek care, you can call your primary care provider.

Behavioral Health Hotline

Our health plan covers health for our members as a whole person. That includes help for mental health problems like depression or substance abuse. You can access behavioral health care on your own without a referral.

If you, as a member of the health plan, disagree with the health plan’s decision, you have the right to ask for a State Fair Hearing. You may name someone to represent you by writing a letter to the health plan telling them the name of the person you want to represent you. A doctor or other medical provider may be your representative. If you want to challenge a decision made by your health plan, you or your representative must ask for the fair hearing within 120 days of the date on the health plan’s letter with decision. If you do not ask for the fair hearing within 120 days, you may lose your right to a fair hearing.

To ask for a fair hearing you or your representative should either send a letter to the health plan at: Parkland Community Health PlanAttention: Member AdvocateP.O. Box 569150Dallas, TX 75356‑9150or call: Parkland HEALTHfirst, Medicaid STAR, call 1-888-672-2277.For members who are deaf or hard of hearing, you can call us toll-free at 1-800-735-2989.

Report Fraud, Waste and Abuse

If you suspect a client (a person who receives benefits) or a provider (e.g., doctor, dentist, counselor, etc.) has committed waste, abuse or fraud, you have a responsibility and a right to report it. To report waste, abuse or fraud, gather as much information as possible and report providers or clients directly to:

Or, if you have access to the Internet go to HHSC OIG and choose “Reporting Waste, Abuse and Fraud”. The site provides information on the types of waste, abuse and fraud to report. If you do not have Internet access and prefer to talk to a person, call the Office of Inspector General (OIG) Fraud Hotline at 1-800-436-6184, or you may send a written statement to the following OIG addresses:

Contact our Provider Relations group for important details about our clinical programs and guidelines as well as resources to assist you with coding, billing practices, formularies and improving patient care quality.

You are now leaving Parkland Community Health Plan

Links to various Parkland Community Health Plan and non-Parkland Community Health Plan sites are provided for your convenience.Parkland Community Health Plan is not responsible or liable for non-Parkland Community Health Plan content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.